"Insurance expenses are staggeringly high"

In the province of Quebec, the rising cost of medications is increasingly becoming a strain on workers' budgets. All Quebecers are required to have medication insurance, which can come from the public regime (RAMQ) or a private regime, often provided by an employer.

A notable difference exists between the fees charged by pharmacists for those covered by a private collective insurance regime and those covered publicly by the RAMQ. This pricing discrepancy often results in a higher financial burden on individuals insured privately, as private insurers and pharmacy benefit managers (PBMs) negotiate rates that can vary significantly and are not subject to the standardized reimbursement limits set by public insurance programs like Medicaid or Medicare.

The Federation of Health and Social Services Unions of Quebec (FSSS-CSN) attributes the increase in regime costs to two main factors: increasingly expensive medications and higher pharmacist fees for those covered by a private collective insurance regime than for those covered publicly by the RAMQ.

Privately insured individuals may face higher out-of-pocket costs because private insurers might place drugs on higher formulary tiers due to cost-containment strategies, increasing co-pays and overall financial burden. In contrast, public insurance beneficiaries generally benefit from more standardized and often lower fees, but this can sometimes limit pharmacy reimbursement and service scope, potentially affecting access or service quality.

Managed care organizations (MCOs) administering Medicare Part D or Medicaid face pressure to contain costs, sometimes leading them to adopt more restrictive formularies or step therapy protocols that indirectly affect patient cost-sharing and access.

In an effort to help consumers make informed decisions, insurers like Beneva and Desjardins now offer their members an online service that compares the price of medications in different pharmacies. The Ministry of Health and Social Services (MSSS) is also aware of the gap between public and private regimes and has launched work "to better document the situation."

The cost of collective insurance is a significant financial burden for many workers, representing up to 20% of their annual gross income. Workers are increasingly settling for minimum coverage to save money, with 49% of workers in the health network having minimum coverage in 2025, compared to 26% in 2016.

The Quebec Association of Pharmacy Owners (AQPP) states that fees should reflect the complexity of the medication and the extent of the monitoring that needs to be done. However, the FSSS-CSN is pressing the MSSS to align the fees of pharmacists between private regimes and the public regime, citing the Quebec Pharmacists' Code of Ethics, which states that the pharmacist must charge "a fair and reasonable price" for their pharmaceutical services.

Individuals like Steve Boutin, a maintenance supervisor, are feeling the pinch of these high costs. Boutin spends over $4,500 a year on family collective insurance, even with minimum protection, and now compares pharmacies before making purchases due to the significant variation in fees. Benefits officer Virginie Lebrun at the Lanaudière Integrated Health and Social Services Centre (CISSS) also spends over $300 a month in premiums for her two children.

In summary, while public insurance regimes help contain pharmacist fees through regulation and standardization, private insurance pricing discrepancies often increase the financial burden on insured individuals. These differences impact access to medications and out-of-pocket costs, with private insurance beneficiaries commonly bearing higher direct costs for pharmacy services.

The pricing discrepancy between public and private insurance regimes in Quebec can be detrimental to consumers' personal-finance, as privately insured individuals may face higher out-of-pocket costs due to varying pharmacist fees and drug formulary tiers.
Science and research in the field of health-and-wellness could potentially address the rising cost of medications, thereby alleviating the financial burden on both public and private insurance beneficiaries.
To ensure justice in the pharmaceutical sector, it is crucial for the Ministry of Health and Social Services (MSSS) to consider policies that promote fairness and standardization in pharmacist fees, particularly between public and private regimes, in accordance with the Quebec Pharmacists' Code of Ethics.